Background With increasing demand for red meat in Tanzania comes heightened potential for zoonotic infections in animals and humans that disproportionately affect poor communities. A range of frontline government employees work to protect public health, providing services for people engaged in animal-based livelihoods (livestock owners and butchers), and enforcing meat safety and food premises standards. In contrast to literature which emphasises the inadequacy of extension support and food safety policy implementation in low- and middle-income countries, this paper foregrounds the ‘street-level diplomacy’ deployed by frontline actors operating in challenging contexts. Methods This research is based on semi-structured interviews with 61 government employees, including livestock extension officers/meat inspectors and health officers, across 10 randomly-selected rural and urban wards. Results Frontline actors combined formal and informal strategies including the leveraging of formal policy texts and relationships with other state employees, remaining flexible and recognising that poverty constrained people’s ability to comply with health regulations. They emphasised the need to work with livestock keepers and butchers to build their knowledge to self-regulate and to work collaboratively to ensure meat safety. Remaining adaptive and being hesitant to act punitively unless absolutely necessary cultivated trust and positive relations, making those engaged in animal-based livelihoods more open to learning from and cooperating with extension officers and inspectors. This may result in higher levels of meat safety than might be the case if frontline actors stringently enforced regulations. Conclusion The current tendency to view frontline actors’ partial enforcement of meat safety regulations as a failure obscures the creative and proactive ways in which they seek to ensure meat safety in a context of limited resources. Their application of ‘street-level diplomacy’ enables them to be sensitive to local socio-economic realities, to respect local social norms and expectations and to build support for health safety interventions when necessary. More explicitly acknowledging the role of trust and positive state-society relations and the diplomatic skills deployed by frontline actors as a formal part of their inspection duties offers new perspectives and enhanced understandings on the complicated nature of their work and what might be done to support them. Electronic supplementary material The online version of this article (10.1186/s12889-019-7067-8) contains supplementary material, which is available to authorized users.

BackgroundResearch has shown that gender is a significant determinant of health-seeking behavior around the world. Gender power relations and lay etiologies of illness can influence the distribution of household resources, including for healthcare. In some rural settings in Africa, gender intersects with multiple forms of health inequities, from proximal socio-cultural factors to more “upstream” or distal health system determinants which can amplify barriers to health-seeking for specific groups in specific contexts.AimWe used an intersectionality approach to determine how women in particular, experience gendered barriers to accessing healthcare among Maa and non-Maa speaking agro-pastoralists in northern Tanzania. We also explored lay etiologies of febrile illness, perceptions of health providers and rural health-seeking behavior in order to identify the most common barriers to accessing healthcare in these settings.MethodsMixed method ethnographic approaches were used to collect data between 2016 and 2018 from four Maa-speaking and two Swahili-speaking agro-pastoralist villages in northern Tanzania. Maa-speaking villages were based in Naiti, Monduli district while non-Maa speaking villages were selected from Msitu in Babati district. Data on health seeking behaviors was collected through semi-structured questionnaires, in-depth interviews, focus group discussions, and home and facility-based participant observation.FindingsThe results primarily focus on the qualitative outcomes of both studies. We found that febrile illness was locally categorized across a spectrum of severity ranging from normal and expected illness to serious illness that required hospital treatment. Remedial actions taken to treat febrile illness included attending local health facilities, obtaining medicines from drug sellers and use of herbal remedies. We found barriers to health-seeking played out at different scales, from the health system, community (inter-household decision making) and household (intra-household decision making). Gender-based barriers at the household had a profound effect on health-seeking. Younger married women delayed seeking healthcare the most, as they often had to negotiate health-seeking with husbands and extended family members, including co-wives and mothers-in-law who make the majority of health-related decisions.ConclusionAn intersectional approach enabled us to gain a nuanced understanding of determinants of health-seeking behavior beyond the commonly assumed barriers such lack of public health infrastructure. We propose tapping into the potential of senior older women involved in local therapy-management groups, to explore gender-transformative approaches to health-seeking, including tackling gender-based barriers at the community level. While these social factors are important, ultimately, improving the public health infrastructure in these settings is a first step toward addressing structural determinants of treatment-seeking.

Since the 1980s, the gender gap in most countries—rich and developing—has been narrowing. Women and girls are going to school more, living longer, getting better jobs, and acquiring legal rights and protections. Despite these strides, women in poor rural communities remain financially excluded from formal financial services. This chapter explores the impact of mobile banking on financial inclusion and women's empowerment in Kenya. The aim is to evaluate whether mobile banking is a form of financial inclusion and women's financial empowerment in Kenya. Firstly, it gives a clear background of a form of mobile banking in Kenya locally called M-PESA. Secondly, it evaluates how M-PESA is a form financial inclusion. Thirdly, it examines if M-PESA is a form of financial empowerment for women and girls in Kenya and lastly, offers recommendations on how M-PESA can effectively become a mode of financial inclusion and women's empowerment in Kenya.

This paper explores access to water, sanitation, and health in pastoral communities in northern Tanzania. It argues that the concept of gender, used on its own, is not enough to understand the complexities of sanitation, hygiene, water, and health. It explores pastoralists’ views and perspectives on what is ‘clean’, ‘safe’, and ‘healthy’, and their need to access water and create sanitary arrangements that work for them, given the absence of state provision of modern water, sanitation, and hygiene (WASH) infrastructure. Although Tanzania is committed to enhancing its citizens’ access to WASH services, pastoral sanitation and hygiene tend to be overlooked and little attention is paid to complex ways in which access to ‘clean’ water and ‘adequate sanitation’ is structured in these communities. This paper offers an intersectional analysis of water and sanitation needs, showing how structural discrimination in the form of a lack of appropriate infrastructure, a range of sociocultural norms and values, and individual stratifiers interact to influence the sanitation and health needs of pastoralist men, women, boys, and girls.

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This paper interrogates the contradictions in the presentation of masculine identities in African literature and Kenyan literature in particular. This is done through a critical reading of Marjorie Oludhe’s Coming to birth. In the main, the paper examines the construction of masculinity in the society with a focus on gender roles, stereotypes, behaviour and general presentation of masculine qualities. In order to do this, the paper analyses how the rural and urban setups as presented in Coming to birth influence and alter the construction, maintaining and portrayal of masculinity as explored in the representative text. This approach allows for the interrogation of masculine behaviours and men’s struggle to perform masculine qualities and expectations fitting their identity. It is worth noting that the portrayal of male characters’ qualities in Coming to birth is marked by a level of frustration, anxiety, unfulfillment and hopelessness in the quest by men to show their masculine nature albeit elusive.

The Covid-19 pandemic has exacerbated and drawn fresh attention to long-standing systemic weaknesses in health and economic systems. The virus – and the public health response – has wrought significant disruption on sexual and reproductive health and rights (SRHR) and maternal, neonatal and child health (MNCH) in Bangladesh. Known negative health outcomes include increased domestic and gender-based violence, child marriage, negative mental health, and adverse child health outcomes. This scoping paper for the Covid-19 Learning, Evidence and Research Programme for Bangladesh (CLEAR) aims to inform future research and policy engagement to support response, recovery, progress, and future health system resilience for SRHR and MNCH in Bangladesh, following the Covid-19 crisis. We present what is known on disruptions and impacts, as well as evidence gaps and priority areas for future research and engagement.

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